Patients with pre-diabetes and severe obesity who had metabolic and bariatric surgery were 20 times less likely to develop full-blown type 2 diabetes over the course of 15 years than patients with the condition who did not have surgery, according to a study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.
"This is the first study to analyse the long-term impact of metabolic and bariatric surgery on the potential progression of prediabetes and the impact is significant and durable," said Dr David Parker, study co-author and a bariatric surgeon at Geisinger Medical Center in Danville, PA. "It demonstrates that metabolic surgery is as much a treatment as it is a prevention for diabetes."
This retrospective study included 1,326 patients who had prediabetes before undergoing either Roux-en-Y gastric bypass (n=1,154) or sleeve gastrectomy (n=172) between 2001 and 2022. Non-surgical controls from a primary care cohort were propensity matched by haemoglobin A1c, age, sex, and body mass index (BMI). More than 80% of patients were female, an average of 45 with a mean BMI of 46.9, and median follow-up 7.2 years.
Only 1.8% of patients progressed to a diagnosis of diabetes in five years after metabolic surgery (Roux-en-Y gastric bypass or sleeve gastrectomy), which rose to 3.3% after ten years and 6.7% after 15 years. The protective effect against diabetes was higher among gastric bypass patients.
Meanwhile, nearly a third (31.1%) of patients with no prior metabolic surgery saw their prediabetes develop into diabetes within five years, which increased to 51.5% and 68.7% at ten and 15 years, respectively. Patients on average lost 29.4% of their body weight at 12 months and 27.6% at 36 months. Greater weight loss at three years was associated with a lower risk of progression to diabetes.
"Think of all the negative health consequences from diabetes [that] patients may avoid through metabolic surgery," said Dr Marina Kurian, ASMBS President, who was not involved in the study. "Prevention of diabetes is the best treatment."
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